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General NPI Number Information
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NPI Number | 1730586926
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Entity Type | Organization
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Legal Business Name | LIFESTYLE AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 110 N ROBINSON ST SUITE 101
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City | RICHMOND
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State | VA
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Zip | 23220-4459
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Country | US
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Telephone | 202-669-8149
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Fax |
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Provider Business Mailing Address
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Address Line | 110 N ROBINSON ST SUITE 101
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City | RICHMOND
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State | VA
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Zip | 23220-4459
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Country | US
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Telephone | 202-669-8149
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATANIA AKERS-WHITE
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Credential | MD
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Telephone | 202-669-8149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101248716
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License Number State | VA
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